Petek Davorina, Ferligoj Anuska, Platinovsek Rok, Kersnik Janko
Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Poljanski nasip 58, Ljubljana, Slovenia.
Croat Med J. 2011 Dec 15;52(6):718-27. doi: 10.3325/cmj.2011.52.718.
To attempt to develop a model of predictors for quality of the process of cardiovascular prevention in patients at high risk of cardiovascular disease (CVD).
We formed a random sample of patients from a stratified sample of 36 family practice registers of patients at high risk of CVD without diabetes and without established CVD. Data were gathered by chart audit and questionnaires about patient and practice characteristics. We defined the process of care as a dependent variable by principle component analysis and tested the relationship of the process with several independent variables (family physicians', patients', and practice characteristics). To study the effects of independent variables (predictors) on the process of care we carried out multilevel regression analysis with the patients constituting the lower level and nested within the family physician/practice (the second level).
Multilevel regression analysis included 645 patients from 36 practices (74.1% from the final sample). Patients' characteristics that predicted the higher-quality process of CVD prevention were younger age (t=-4.94, 95% confidence interval [CI] -0.018 to -0.008) and lower socioeconomic status (t=-2.18, 95%CI -0.195 to -0.010). Practice characteristics that predicted the higher-quality process of CVD prevention were smaller practice size (t=2.83, 95% CI 0.063 to 1.166), a good information system for CVD prevention (t=3.15, 95% CI 0.030 to 0.282), and the organization of education on CVD prevention (t=3.19, 95%CI 0.043 to 0.380).
This study shows that the quality of cardiovascular prevention could be measured as a composite outcome and future studies should further develop this approach and test the impact of several practice/patient characteristics on the quality of CVD prevention with the international data.
尝试建立心血管疾病（CVD）高危患者心血管预防过程质量的预测模型。
我们从36个家庭医疗登记处的分层样本中随机抽取患者，这些登记处的患者为无糖尿病且未确诊CVD的CVD高危患者。通过病历审查和关于患者及医疗服务特征的问卷收集数据。我们通过主成分分析将护理过程定义为因变量，并测试该过程与几个自变量（家庭医生、患者及医疗服务特征）之间的关系。为研究自变量（预测因素）对护理过程的影响，我们进行了多层次回归分析，患者构成较低层次，并嵌套在家庭医生/医疗服务机构（第二层次）内。
多层次回归分析纳入了来自36个医疗服务机构的645名患者（占最终样本的74.1%）。预测CVD预防过程质量较高的患者特征为年龄较小（t=-4.94，95%置信区间[CI]-0.018至-0.008）和社会经济地位较低（t=-2.18，95%CI-0.195至-0.010）。预测CVD预防过程质量较高的医疗服务特征为医疗服务规模较小（t=2.83，95%CI0.063至1.166）、良好的CVD预防信息系统（t=3.15，95%CI0.030至0.282）以及CVD预防教育的组织（t=3.19，95%CI0.043至0.380）。
本研究表明，心血管预防质量可作为综合结果进行衡量，未来研究应进一步拓展此方法，并利用国际数据测试多种医疗服务/患者特征对CVD预防质量的影响。
